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Sleep Apnea: Should I Have Surgery?

Guides through decision to have surgery for sleep apnea. Discusses problems like depression and high blood pressure associated with lack of treatment. Covers alternatives to surgery. Includes interactive tool to help you make your decision.

Sleep Apnea: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Your options

Key points to remember

It's important to treat obstructive
sleep apnea, because sleep apnea makes you more likely to have
high blood pressure,
depression,
irregular heart rhythms,
heart failure,
coronary artery disease, and
stroke.

Your doctor will probably have
you try lifestyle changes and
CPAP (continuous positive airway pressure)
first. Surgery is a first choice only if the sleep apnea is caused by a
blockage that surgery can easily fix.

There is no good evidence on how well the surgery called
UPPP (which removes excess tissue in your throat)
works for sleep apnea.1 There is a little evidence
that shows that it helps 40 to 60 out of every 100 people who try it.2 You may still need
CPAP after this surgery.

The surgery called
tracheostomy (which puts a permanent opening in your
neck to your windpipe) almost always cures sleep apnea that is caused by
blockage of the upper airway. But other treatments work almost as well in most
people. And the surgery can cause many complications.

Other types of surgery that may be used to treat sleep apnea include:

Maxillo-mandibular advancement, which moves the upper and lower jaw forward to increase the size of the airway.

Radiofrequency ablation, which reduces the size of the tongue or other tissue that may be blocking airflow to the lungs.

Palatal implants, which are small plastic rods that are implanted in the soft palate. They make the soft palate stiffer to keep the tissue from blocking the airway.

Laser-assisted uvulopalatoplasty (LAUP), which reshapes the tissue of the palate so it does not block the airway.

If you are
very overweight,
bariatric surgery may help you lose weight. Losing
weight may improve your sleep apnea or end it completely.3

Your throat muscles and tongue relax during
sleep and partially or completely block the airways in your nose, mouth, or
throat.

Bone deformities or enlarged tissues block your airways.
For example, you may have enlarged
tonsils. During the day when you are awake and
standing up, this may not cause problems. But when you lie down at night, the
tonsils can press down on your airway, narrowing it and causing sleep
apnea.

Personal stories about treatment for obstructive sleep apnea

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have been
using continuous positive airway pressure (CPAP) to treat my sleep apnea for
over a year. Since I travel a lot, CPAP isn't very convenient for me. Taking my
CPAP machine on business trips is too much trouble for me. I talked with my
doctor, and we agreed that surgery might be a good option to treat my sleep
apnea.

Jorge, age
54

CPAP is doing wonders for my sleep apnea.
It really isn't that much of a bother for me to use. I also read that surgery
may only help about half of the time. I am not willing to risk the
complications from surgery, so I am going to continue with CPAP.

Dara, age
42

I have been using CPAP. I am tired of
being attached to a machine at night while I sleep. My nose is always dry, and
I have been having terrible nightmares. My sleep is not improving. I am willing
to have surgery to treat my sleep apnea if it can help.

Cal, age 45

Since I have been using CPAP, my sleep
apnea symptoms have disappeared. My wife can't believe the change in my
attitude during the day. We talked about my having surgery to treat my sleep
apnea so I wouldn't have to use CPAP anymore. My doctor said that even if I
have the surgery, I still might have to use CPAP. The risks and cost of the
surgery and the possibility that I might still have to be on CPAP are not worth
it.

Gordon,
age 50

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for sleep apnea

Reasons not to have surgery

I'm willing to try surgery to get better.

I want to avoid surgery at all costs.

More important

Equally important

More important

I want to try surgery even though I know I may have to go back to using CPAP afterward.

I don't want to go through surgery if there's a chance I'll have to go back to using CPAP anyway.

More important

Equally important

More important

My appearance after a tracheostomy—having a hole in my throat—won't bother me.

I don't like the idea of living with a hole in my throat.

More important

Equally important

More important

I don't like the side effects of using CPAP, so I rarely use it.

The side effects of CPAP aren't bad enough to keep me from using it.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Trying other treatments

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Do you need treatment even if your sleep apnea doesn't bother you too much?

YesYes, you're right. It's important to treat sleep apnea, because it makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.

NoNo, that's wrong. It's important to treat sleep apnea, because it makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.

I'm not sureIt may help to go back and read "Get the Facts." It's important to treat sleep apnea, because it makes you more likely to have other serious problems.

2.

Is surgery usually a doctor's first choice in treating sleep apnea?

YesSorry, that's wrong. Your doctor will probably have you try lifestyle changes and CPAP first. Surgery is a first choice only if the sleep apnea is caused by a blockage that is easily fixed.

NoYou're right. Your doctor will probably have you try lifestyle changes and CPAP first. Surgery is a first choice only if the sleep apnea is caused by a blockage that is easily fixed.

I'm not sureIt may help to go back and read "Get the Facts." Surgery is a first choice only if the sleep apnea is caused by a blockage that is easily fixed.

3.

Does research show that UPPP works well for sleep apnea?

YesNo, that's wrong. There is no good evidence on how well UPPP works for sleep apnea.

NoYou're right. There is no good evidence on how well UPPP works for sleep apnea.

I'm not sureIt may help to go back and read "Get the Facts." There is no good evidence on how well UPPP works for sleep apnea.

4.

Does tracheostomy almost always cure sleep apnea?

YesThat's right. A tracheostomy nearly always cures sleep apnea. But it leaves a hole in your throat where the breathing tube sits.

NoSorry, you're wrong. A tracheostomy nearly always cures sleep apnea. But it leaves a hole in your throat where the breathing tube sits.

I'm not sureIt may help to go back and read "Compare Your Options." A tracheostomy nearly always cures sleep apnea. But it leaves a hole in your throat where the breathing tube sits.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Sleep Apnea: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery for sleep apnea.

Do not have surgery.

Key points to remember

It's important to treat obstructive
sleep apnea, because sleep apnea makes you more likely to have
high blood pressure,
depression,
irregular heart rhythms,
heart failure,
coronary artery disease, and
stroke.

Your doctor will probably have
you try lifestyle changes and
CPAP (continuous positive airway pressure)
first. Surgery is a first choice only if the sleep apnea is caused by a
blockage that surgery can easily fix.

There is no good evidence on how well the surgery called
UPPP (which removes excess tissue in your throat)
works for sleep apnea.1 There is a little evidence
that shows that it helps 40 to 60 out of every 100 people who try it.2 You may still need
CPAP after this surgery.

The surgery called
tracheostomy (which puts a permanent opening in your
neck to your windpipe) almost always cures sleep apnea that is caused by
blockage of the upper airway. But other treatments work almost as well in most
people. And the surgery can cause many complications.

Other types of surgery that may be used to treat sleep apnea include:

Maxillo-mandibular advancement, which moves the upper and lower jaw forward to increase the size of the airway.

Radiofrequency ablation, which reduces the size of the tongue or other tissue that may be blocking airflow to the lungs.

Palatal implants, which are small plastic rods that are implanted in the soft palate . They make the soft palate stiffer to keep the tissue from blocking the airway.

Laser-assisted uvulopalatoplasty (LAUP), which reshapes the tissue of the palate so it does not block the airway.

If you are
very overweight,
bariatric surgery may help you lose weight. Losing
weight may improve your sleep apnea or end it completely.3

FAQs

What is obstructive sleep apnea?

Sleep apnea occurs when you often stop breathing for
10 seconds or longer during sleep. This may happen 5 to 50 times an hour. The
more often it happens, the more serious the apnea is.

What causes obstructive sleep apnea?

Sleep apnea occurs when:

Your throat muscles and tongue relax during
sleep and partially or completely block the airways in your nose, mouth, or
throat.

Bone deformities or enlarged tissues block your airways.
For example, you may have enlarged
tonsils. During the day when you are awake and
standing up, this may not cause problems. But when you lie down at night, the
tonsils can press down on your airway, narrowing it and causing sleep
apnea.

Other problems may
include pain, infection, speech problems, and a narrowing of the airway in the
nose and throat.

The main side effect of
tracheostomy is that you have a hole in your throat
where the breathing tube sits. Other risks may include:

Scar tissue forming at the opening of the
hole in your throat.

Trouble speaking.

An increased
risk of lung infections.

Emotional problems, such as depression or
a change in self-image.

The risks of MMA and LAUP are:

Changes in appearance and in how the teeth meet.

Jaw numbness and problems swallowing.

Infection.

RFA for sleep apnea can cause:

Damage to tissue near the area being treated.

Infection.

Bleeding from the treated area.

The use of palatal implants can result in:

Changes in how the teeth meet.

Being able to feel the implants, which may be uncomfortable.

Loss of an implant, which would have to be reimplanted.

Lifestyle
changes and CPAP may not be enough if your sleep apnea is very bad.

CPAP side effects may include nosebleeds, a sore
throat, and headaches.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about treatment for obstructive sleep apnea

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have been using continuous positive airway pressure (CPAP) to treat my sleep apnea for over a year. Since I travel a lot, CPAP isn't very convenient for me. Taking my CPAP machine on business trips is too much trouble for me. I talked with my doctor, and we agreed that surgery might be a good option to treat my sleep apnea."

— Jorge, age
54

"CPAP is doing wonders for my sleep apnea. It really isn't that much of a bother for me to use. I also read that surgery may only help about half of the time. I am not willing to risk the complications from surgery, so I am going to continue with CPAP."

— Dara, age
42

"I have been using CPAP. I am tired of being attached to a machine at night while I sleep. My nose is always dry, and I have been having terrible nightmares. My sleep is not improving. I am willing to have surgery to treat my sleep apnea if it can help."

— Cal, age 45

"Since I have been using CPAP, my sleep apnea symptoms have disappeared. My wife can't believe the change in my attitude during the day. We talked about my having surgery to treat my sleep apnea so I wouldn't have to use CPAP anymore. My doctor said that even if I have the surgery, I still might have to use CPAP. The risks and cost of the surgery and the possibility that I might still have to be on CPAP are not worth it."

— Gordon,
age 50

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for sleep apnea

Reasons not to have surgery

I'm willing to try surgery to get better.

I want to avoid surgery at all costs.

More important

Equally important

More important

I want to try surgery even though I know I may have to go back to using CPAP afterward.

I don't want to go through surgery if there's a chance I'll have to go back to using CPAP anyway.

More important

Equally important

More important

My appearance after a tracheostomy—having a hole in my throat—won't bother me.

I don't like the idea of living with a hole in my throat.

More important

Equally important

More important

I don't like the side effects of using CPAP, so I rarely use it.

The side effects of CPAP aren't bad enough to keep me from using it.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Trying other treatments

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Do you need treatment even if your sleep apnea doesn't bother you too much?

Yes

No

I'm not sure

Yes, you're right. It's important to treat sleep apnea, because it makes you more likely to have high blood pressure, depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.

2.
Is surgery usually a doctor's first choice in treating sleep apnea?

Yes

No

I'm not sure

You're right. Your doctor will probably have you try lifestyle changes and CPAP first. Surgery is a first choice only if the sleep apnea is caused by a blockage that is easily fixed.

3.
Does research show that UPPP works well for sleep apnea?

Yes

No

I'm not sure

You're right. There is no good evidence on how well UPPP works for sleep apnea.

4.
Does tracheostomy almost always cure sleep apnea?

Yes

No

I'm not sure

That's right. A tracheostomy nearly always cures sleep apnea. But it leaves a hole in your throat where the breathing tube sits.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

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How this information was developed to help you make better health decisions.